Evan James Limited
Fine Jewelers and Goldsmiths

APPLICATION FOR EMPLOYMENT

Evan James Ltd. considers applicants for all positions without regard to race, color, religion, national origin, ancestry, sec, sexual orientation, marital status, age, veteran status, HIV status, disability or any other legally protected category.

PERSONAL BACKGROUND INFORMATION

Date Social Security Number

First Name MI Last Name

Current Address

Home Telephone Work Telephone

Previous Address

Do you have the legal right to work in the United States? Yes No
(According to Federal Law, work authorization documentation will be required upon employment)

Are you below the age of 18? Yes No

EMPLOYMENT INTEREST

Position Applying For

Type of Work Full Time Part-Time Other

Minimum Wage Requirement Date Available to Work

Are you available to work overtime? Yes No

Are you available to work weekends? Yes No

Do you have reliable transportation to and from work? Yes No

Are you available to travel if required? Yes No

Referral Source Ad Employee Web site Internet
Other

EDUCATION BACKGROUND INFORMATION

High School or Preparatory: Name:
Address:
Course of Study: Degree/Diploma:

College or University: Name:
Address:
Course of Study: Degree/Diploma:

Graduate School: Name:
Address
Course of Study: Degree/Diploma

Other Professional Schools: Name:
Address:
Course of Study: Degree/Diploma:

List any honors, awards or recognition received (include professional, educational or military)

EMPLOYMENT HISTORY

List all employment, including self-employment beginning with the most recent position. You may include any volunteer work performed.

Company Telephone
Address
Dates Employed:
From to Supervisor's Name
Job Title/Duties
Reason for Leaving Salary

Account for all periods of unemployment of two weeks or more in the last ten years.

From: MO/YR
1. a) b) c)
To: MO/YR
a) b) c)
Reasons:
1. a) b) c)

Have you ever been discharged or requested to resign from a position? Yes No
(if yes, please explain)

List all applicable computer, technical and/or specialized skills:

SECURITY INFORMATION

Have you ever been convicted or placed on probation for a misdemeanor or felony?
Yes
No
If yes, please explain
If requested to do so, I hereby agree to obtain my criminal record from the Vermont Criminal Information Center in accordance with its procedures. Yes No

PLEASE READ BEFORE SIGNING

It is my understanding that this employment application, or the granting of a personal interview, does not represent a contract of employment or a promise of future benefits by Evan James Ltd. I understand and agree that if hired, my employment will be at-will in nature and may be terminated, with or without cause, at any time, by either myself or my employer, I also understand that this written statement supersedes any and all oral representations made my agents or representatives of Evan James Ltd.

I hereby authorize persons, schools, my current employer (if applicable), previous employers and organizations named in this application and accompanying resume, if any, to provide any relevant information that may be required to arrive at an employment decision. I acknowledge that this information is provided at my request and for my benefit. I hereby hold all such persons and entities harmless, and do hereby release them from any such claims or liability, whatsoever, including but not limited to claims for defamation or for interference with actual or prospective employers for furnishing any of the above mentioned information and material.

I certify that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing that would, if disclosed, affect this application unfavorably. I understand that incomplete, incorrect or false information may disqualify me from employment, in addition to being ground for disciplinary action up to and including termination should I secure employment.

Electronic Signature Date

48 Main Street - Brattleboro VT 05301
802-254-3333 | 800-EVAN-LTD | 800-382-6583